Knowledge and Management of Alarm Fatigue on a Medical Intermediate Care Unit Kathleen A. Williams, SN Introduction The purpose of this project is to improve.

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Knowledge and Management of Alarm Fatigue on a Medical Intermediate Care Unit Kathleen A. Williams, SN Introduction The purpose of this project is to improve nurses’ knowledge and management of alarm fatigue on the Medical Intermediate Care Unit at Hershey Medical Center. Methods Survey response 30/48 for an overall response rate of 62.5%. Knowledge deficits identified in the following areas: definition and impact of alarm fatigue; current alarm monitor policy; practice points for management of alarms. Following distribution of flyer and educational intervention, 25/48 signatures were obtained for an educational impact of 52%. Discussion The vast majority of alarms are false (85-99%). Nurses on the MIMCU expressed frustration at how disruptive false alarms are to daily workflow (8.1 out of 10). A count of alarms in a 24-hour period revealed an average of 260 alarms per bed per day with maximum daily alarms per bed as high as 1,000. False alarms lead to the potential of ignoring or missing important alarms. 90% of nurses on the MIMCU have witnessed delays in response to an urgent alarm situation and almost half have witnessed patient harm in the last year as a result of alarm fatigue. Conclusions and Implications for Practice Initial and ongoing education is beneficial to increasing nurses’ knowledge of alarm fatigue and methods of alarm management. Translation of knowledge into practice is expected to decrease noncritical alarms to reduce alarm fatigue and improve patient safety. References Borowski, M., Gorges, M., Fried, R., Such, O., Wrede, C., & Imhoff, M. (2011). Medical device alarms. Biomedical Tech (Berl), 56(2), doi: /BMT Cvach, M. (2012). Monitor alarm fatigue: An integrative review. Biomedical Instrumentation & Technology, 46(4), Retrieved from Cvach, M. M., Biggs, M., Rothwell, K. J., & Charles-Hudson, C. (2013). Daily electrode change and effect on cardiac monitor alarms: An evidence-based approach. Journal of Nursing Care Quality, 28(3), doi: /NCQ.0b013e bc Dandoy, C. E., Davies, S. M., Flesch, L., Hayward, M., Koons, C., Coleman, K.,…Weiss, B. (2014). A team- based approach to reducing cardiac monitor alarms. Pediatrics, 134(6), doi: /peds Funk, M., Winkler, C. G., May, J. L., Stephens, K., Fennie, K. P., Rose, L. L., … Drew, B. J. (2010). Unnecessary arrhythmia monitoring and underutilization of ischemia and QT interval monitoring in current clinical practice: Baseline results of the Practical Use of the Latest Standards for Electrocardiography (PULSE) Trial. Journal of Electrocardiology, 43(6), 542–547. doi.org.ezaccess.libraries.psu.edu/ /j.jelectrocard Gazarian, P. K., Carrier, N., Cohen, R., Schram, H., & Shiromani, S. (2014). A description of nurses’ decision- making in managing electrocardiographic monitor alarms. Journal of Clinical Nursing, 24, doi: /jocn Gorges, M., Markewitz, B., Westenskow, D. R. (2009). Improving alarm performance in the medical intensive care unit using delays and clinical context. Anesthesia & Analgesia, 108(5), doi: /ane.0b013e31819bdfbb Graham, K. C., & Cvach, M. (2010). Monitor alarm fatigue: Standardizing use of physiological monitors and decreasing nuisance alarms. American Journal of Critical Care, 19(1), doi: /ajcc Gross, B., Dahl, D., & Nielsen, L. (2011). Physiologic monitoring alarm load on medical/surgical floors of a community hospital. Biomedical Instrumentation & Technology: Alarm Systems, 45(1), doi: Joint Commission (2013). The Joint Commission sentinel event alert: Medical device alarm safety in hospitals. Retrieved from Kerr, J. H., & Hayes, B. (1983). An “alarming” situation in the intensive therapy unit. Intensive Care Medicine, 9(3), Retrieved from Stokowski, L. A. (2014). Time to battle alarm fatigue: Better monitoring and management. Retrieved from Walsh-Irwin, C., & Jurgens, C. Y. (2015). Proper skin preparation and electrode placement decreases alarms on a telemetry unit. Dimensions of Critical Care Nursing, 34(3), doi: /DCC Weil, K. M. (2009). Alarming monitor problems. Nursing, 39(9), 58. doi: /01.NURSE b8. Welch, J. (2011). An evidence-based approach to reduce nuisance alarms and alarm fatigue. Biomedical Instrumentation & Technology: Alarm Systems, 45(1), doi: 45.s1.46 Whalen, D. A., Covelle, P. M., Piepenbrink, J. C., Villanova, K. L, Cuneo, C. L., & Awtry, E. H. (2014). Novel approach to cardiac alarm management on telemetry units. Journal of Cardiovascular Nursing, 29(5), doi: /JCN Administer survey via SurveyMonkey to nursing staff. Identify gaps in knowledge. Create educational flyer from research of current best evidence. Distribute flyer and other supportive handouts. Educate staff at each shift change and other opportunities as they present. Obtain staff signatures confirming receipt of education and commitment to expected practice and nursing actions. Results Infographic - Physician-Patient Alliance for Health & Safety -